minten
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Posts posted by minten
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Why are some of you people so obsessed with being proven right (or: making sure we all know somebody else was wrong)? It's so painfully obvious none of us were right, not even remotely, and nobody was "less wrong" than anybody else. As data comes in the truth appears to be more and more somewhere in the middle between what we were all saying. Can't we just accept that and move on by posting interesting articles etc... I mean, do whatever you want, but it's so stupid.
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Preliminary NY sttudy says 21.2% of NYC has antibodies.
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A humanitarian reason for opening up the economies around the world:
"Coronavirus pandemic will cause global famines of 'biblical proportions,' UN warns"\
"While dealing with a Covid-19 pandemic, we are also on the brink of a hunger pandemic," David Beasley told the UN's security council. "There is also a real danger that more people could potentially die from the economic impact of Covid-19 than from the virus itself."
https://www.cnn.com/2020/04/22/africa/coronavirus-famine-un-warning-intl/index.html
Yes, it is from CNN, not Fox.
We all know we won't care because it won't be us. It's a point i've been trying to make since the start.
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Base case: constant caseload, rolling lockdowns, 1% of the world population dies (80M) or whatever the true death rate is. Bad for the economy also.
I don't want to come across as cynical or anything (and I'm definitely not making any immoral suggestions), but if you look at the profile of that 1% I'm not so sure that would be bad for the economy as a whole at all.
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https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1
another antibody test study: " Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). "
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The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.
“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.
The lack of a control arm in the study could make interpreting the results more challenging.
Looks promising. No control arm in the study is a caveat.
Market seems to absolutely love this. GILD up 15% in after hours, SPY up 3.5%. Wow.
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I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.
Is 3% much above the false positive rate for these anti-body tests?
The researchers claim the anti-body test is not accurate enough to tell a certain person on an individual basis whether or not they have antibodies because of the false positives, but by looking at an entire group the results are reliable for that group. I can only assume that means they are correcting for the false positive rate. This is a study by a research institute. We'd have to wait for the final results what they did exactly, but doesn't sound like this was a study done by some group of overenthusiastic amateurs who were not aware of this.
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is it not credible to at least question these people?
There's definitely a time and place for questioning (and even for fund cutting if need be), I totally agree; But surely we can also all agree that time is not now.
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I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).
Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths. 3% of 17 million is 500K. So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.
So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard. On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).
This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.
It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.
What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.
@LC
Thank you for supplying the link for the European monitoring of mortality with seasonal variations.
Apologies. To my own embarassment upon re-reading this I made a primary school calculation error here (my only defence: it was early). 3100 out of 500 000 obviously isn't 0.06%, but 0.6%, which makes quite a bit of difference here, Still not quite the 3% some are saying, but definitely not flu percentages either.
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I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).
Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths. 3% of 17 million is 500K. So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.
So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard. On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).
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That being said I dont think my guesses were too bad.
No, they were appallingly bad, to the extent that I'd lose a some degree of respect for all doctors if it weren't for Dalal's sensible posts on this thread to pull me back off that ledge.
Frankly, it terrifies me that doctors exist who ignore evidence for gut feel, make wild speculations not even supported by common sense let alone facts, and then when the evidence proves them wrong, continue to insist that they were right. (What the heck is one to do if one seriously needs a doctor, and this is the doctor one gets? Just roll over and die?)
That seems a bit harsh to me. I've been in this thread a while now and I know for sure who I'd like my doctor to be (if anyone here is a doctor at all; or maybe we all are, who knows); anyway, I'm pretty sure we all have a conscious or subconscious preference to whatever or whomever fits our pre-existing bias best, so let's not get too personal.
https://www.bloomberg.com/news/articles/2020-04-15/china-s-data-on-symptom-free-cases-reveals-most-never-get-sick. Coincedentally this source reports a similar percentage of asymptomatic patients as Boston's homeless study did (you know, the study nobody said was random). Some of you think it's all China's fault and all China does is lie, bla bla bla, but still.
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"Whoa! 29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"
And now this:
"Whoa, 147 (36%) out of 408 people tested positive for the #coronavirus at a large homeless shelter in Boston
https://medrxiv.org/content/10.1101/2020.04.12.20059618v1. More interestingly, only ~1/6 showed symptoms among those tested positive, i.e. 1:5 for symptomatic vs asymptomatic. #COVID19"
So...um...from the BMJ study:
Upon observing a cluster of COVID-19 cases from a single large homeless shelter in Boston, Boston Health Care for the Homeless Program conducted symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2Does this sound like a random sample? If I tested residents of a nursing home with a large cluster of covid cases, is that result going to give me the population incidence? Or is it going to vastly overestimate it?
Uhm, absolutely nobody said this was a random sample. Even the tweet (which, for clarity, isn't mine) implictly says this by saying "More interestingly ...".
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"Whoa! 29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"
And now this:
"Whoa, 147 (36%) out of 408 people tested positive for the #coronavirus at a large homeless shelter in Boston
https://medrxiv.org/content/10.1101/2020.04.12.20059618v1. More interestingly, only ~1/6 showed symptoms among those tested positive, i.e. 1:5 for symptomatic vs asymptomatic. #COVID19"
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In all the talk about the contact tracing apps nobody seems to want to get into how it will work in practice. If I go out running, and run past someone who is infected, how will the system evaluate risk. How will the system know if and in what way I interacted with this person? If you set the filter too loose, it won't work. If you set it too tight, your whole society will be in quarantine in days and everybody will de-install it within a week. Also, if I sit in locked up my apartment all day, and my infected neighbour will sit 1 meter away for hours in his apartment, but with a wall between us, will the app know there's a wall? I can think of countless more questions like this.
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"Whoa! 29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"
Can anyone think of any reason why late-pregnant women would be more exposed to COVID than the average NY-er (frequent hospital visits maybe)? 13.7% of an asymptomatic subgroup is (obviously) really, really high.
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"Whoa! 29/210 (13.7%) of asymptomatic women admitted for delivery tested positive for the #coronavirus in NYC (3/29 developed fever later) https://nejm.org/doi/full/10.1056/NEJMc2009316"
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Does anyone have decent statistics on survival rate after being put on a ventilator?
My country published survival rates from those admitted to the IC. Not completely the same as being put on a ventilator, as apparently there are those that are admitted to the IC without a ventilator (like Boris Johnson), but it gets close.
Under 40 there are few admissions and virtually everyone surives. From 40-60 most surive, from 60-70 it's a coin flip, over 70 (by far the largest group) most die. The overall surival rate is about 50%. As a side note, old people are very often not admitted to the IC here (because it's a really lonely, terrible way to die), unlike for example in Italy where the culture is different. IC survival rate over there must be much much lower, but I haven't found any proof of that in stats.
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on masks:
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The model used for all of this wildly wrong and NYC discharging way more pts then admitting. ICU need off by a factor of 10x per Cuomos previous comments. Holy shit.
Orthopa:
Along the lines of "unintended consequences - what is your opinion on this article? - which I find surprising:
I keep getting urgent bulletins here in Illinois about the shortage of healthcare workers and a call for them to come out of retirement.
I dont practice in NYC, King County, LA etc but to just give some perspective whats happening here medically.
1. The urgent cares in our network have closed down centers within close proximity on weekends. 15% of centers now closed on weekends. Next step is closing at 6pm instead of 8pm. Volumes are down 80% across the board.
2. ER wait times online averaging 0-10 minutes. There are 5 hospitals in this IDN with these ERs. ~2400 beds total, not sure of bed count.
3. All elective surgery has been cancelled at local hospitals. Nurses are being told to take vacation time/furloughed as there are little no patients on the orthopedic/general surgery floors. OB/GYN still at normal volumes of course. No pre op/post op recovery being done.
4. Im still in contact with many in the orthopedic community and the largest non academic orthopedic group has asked all non provider staff to take 50% pay cuts going forward if salaried. Use vacation/sick time first. All PAs have been furloughed until further notice as its mainly a non trauma/orthopedic group. Ortho surgeons who do sports medicine better have a nice emergency fund saved up.
5. Local surgical centers have shut down. ENT, plastics, ophthalmology, GI docs/PAs, nursing staff same as above.
The hospitals are all emptied, waiting, and ready to go.
Maybe cobfadec and others/relatives/family working in the hospitals can give some color on what they are seeing.
This is my post from 2 weeks ago I believe every bit of that article. I'm not in NYC but am in NY. At least in my area everything was modeled as worst case ie Italy, Spain. One local system has 650 free beds and had 80 corona virus patients as of a couple of days ago. I got a call from NYS DOH 2 weeks ago regarding my skill set experience etc. Haven't heard back since and don't expect to either. I think people in NYC have come out of retirement and or working cross specialty. I dont think its makes much sense to pull anyone else state wide going forward
All that was occurring in my above post is still the same now. Hospital system still shut down outside of emergency surgery, ERs etc. Some of the local hospital employed specialty physicians have been asked to take a pay cut. Low census and no elective surgeries make for no money. Crazy to think hospitals are asking doctors to take a pay cut during a pandemic but what we are seeing in many areas is that the amount of covid patients are not superior to normal patient volume for every day community care. We certainly will see exceptions in "hot spots" but nationwide this is not the case it seems.
out of curiosity: don't you guys in the US move patients around? seems so utterly weird some hospitals are "over-run" (at least that's what we're told in the media), while others in the same state have plenty of spare capacity.
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I understand the desire for a miracle drug, but there are much more promising candidates.
Remdesivir apparently has a clinical trial readout somewhere this week.
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For me the biggest bullish indicator for oil last week was not an OPEC+ meeting, but that Trump seems to want the oil price up at all. I wasn't too sure if he really wanted too, as he'd been pretty silent on the topic and always insisted in the past he actually wanted a low oil price.
And I personally think Trump is an idiot, but he's also very simplistic in always wanting to win something he considers to be a battle, and he's completely unpredictable. By throwing his weight at oil, sending off random tweets that proved to be false, speculating about tariffs, he will no doubt scare everyone around him. Because god knows what moronic destructive course of action Trump might take, just to win a fight he has now picked. Basically this forces everyone around him to have to walk on their toes, because they know the guy sitting on the other end of the negotiation table is a mad-man. It is kind of brilliant actually if it was on purpose.
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I don't understand why the gov't can't just take small equity stakes in companies that will be struggling in the short term but will be successful in the long term. The equity would be without voting rights totally passive and rolled into a sovereign wealth fund for the people to profit off of when the world gets back to normal.
Good companies get liquidity.
The public gets the value of providing capital when it is badly needed.
Win-win
and who decides what companies that struggle short term will be succesful long term? i see huge potential for nepotism here.
also, a structure like this would become a self-fulfilling prophecy, with the market trusting companies that get the government on-board, and distrusting those that don't, regardless of fundamentals.
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So let’s round it off to 3 people. If each of those 3 spread it to 3 more and they spread it to 3 more (already we are up to 81 people) and each of them spread it to 3 more. I mean, in a matter of a week that one single person could have essentially infected thousands.
The basic principle is correct, but your time axis isn't. The virus has a number of days (2-7 I believe) of incubation time in a person, you're not immediately transmitting virus once you get infected, and you'll be most contagious when you're sickest. So, it won't spread to thousands in a matter of a week. Given time and no measures, obviously you'll get the some effect in the end but a lot slower.
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One person can spread the virus to dozens of others, correct? And each one of those can spread it to numerous others so it spreads on an exponancial basis.
Without any containment measures whatsoever the WHO estimates one person with this virus affects 2.5 others. So, while one particular person might spread it to dozens of others, on average they don't (unlike measles for example).
Coronavirus
in General Discussion
Posted
It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding.